Newly diagnosed--Should I ask vet to switch insulins?

Hi Friends,
I'm brand new here and so grateful for all the resources. Here is my story and question:

Tigger and I are one week into her diagnosis. BG was 450 at vet; he prescribed 4 units of Vetsulin twice a day. Tigger was horribly hypo by the second night (four hours after her PM dose). Vet advised to drop to 3 units and to only give a half dose if she doesn't eat. She has always been a grazer and never eats much at once. And I read here and elsewhere that Vetsulin dosage is typically 1 - 2 units. . . . So I tried giving 1.5--no way I was trying 3 units after the horrible crash.

1.5 seemed okay. . . . But then after 3 nights. . . . Again at four hours after PM dose, Tigger threw up some liquid and then was STARVING. Not the huge 4-unit crash, but definitely not right. (I didn't have a meter yet.)

The day after that lighter crash, I skipped both doses. AND (thank goodness) my meter arrived in the mail. Her BG late in the afternoon with no AM shot was 152.

Her AMPS today was 251; I tried 1 unit. Got a 3+ reading of 124, then had to leave for work. . . . This evening is 161, so I have skipped the shot again.

I feel like I'm making this up as I go along. . . . I will continue to home test. . . . Will see vet again Friday. Should I ask for a different insulin? Or is it better to stick with what I've started with? I'm also working on transitioning to Low Carb canned. (Prev. was a mix of dry and canned plus--I realize now--far too many high-carb junky treats.)

Thanks for reading / listening! Tigger and I welcome any advice.

Kerri

 

My goodness. You've certainly gone through a baptism of fire. Glad you found us but so sorry you needed to. Your instincts have served you well and I'm so glad you reduced the dose to 1u. 4 units would be a hefty dose for most kitties and it's huge for a newly diagnosed cat.

You mentioned getting a test of 152 late afternoon with no insulin having been given that AM. It may be that even 1u is more than Tigger needs so monitoring will be key to ensuring Tigger stays safe.

Vetsulin works for some cats but for many it doesn't last long enough through the cycles. Interestingly, with a morning pre-shot of 251, mid cycle of 124 and then a PM pre-shot of 161, it seems Tigger might be getting good duration out of the shots however it's a bit early to know for certain. That particular cycle also makes me question if even 1u might be a bit more insulin than Tigger needs.

Not sure how far you have gone with diet change but switching Tigger to a low carb wet diet from dry, can have a very significant lowering effect on BG and reduce insulin needs. In some cases, cats switched to a canned low carb diet go into remission. I'm wondering if diet change may have played a role in the hypo episode and in the numbers you are currently getting which are getting pretty close to being within normal BG range albeit high normal. In any event I would make diet changes slowly.

I think to be on the safe side, given the number of shots you've had to skip and the readings you have been getting, I'd reduced the dose further to 0.5u providing it's safe to give insulin (pre-shot BG is 250 or above for now) and get mid cycle tests to see how low BG is dropping. Since you are working, I suggest you get some night time tests. Grabbing a test +2 or +3 post shot and also before bed, can provide some good information and if you happen to get up through the night, periodically grabbing a test then is also helpful. Most kitties go lower overnight than they do during the day so getting some night time tests is very important. On days off, randomly testing during the day in the +2 to +7 timeframe concentrating on the +3 to +6 hour post shot period, should identify when Tigger is at the lowest point in his cycle.

Not sure how your vet suggested you feed Tigger, but I would make sure to leave food out for Tigger during the day and overnight so if BG does drop, he has food to eat to get his BG up. Multiple meals or free feeding is better than feeding only with shots. your

It's clear your instincts are serving you well. Tigger is in good hands. I think given the readings you have been getting, I'd give the Vetsulin a little more of a chance. I can't help but wonder if Tigger's BG numbers will come down even more once he is fully transitioned to an all wet low carb diet and if that's the case, there's a chance he won't need the insulin at all. You can always switch to another insulin later if need be.

 

Dear Linda,
Thank you sooooooooo much for offering me such an encouraging and helpful response! I had been wondering about all the things you mentioned--the food changes, the free feeding, and trying an even lower dose--thank you for addressing all of that. I'm also glad it seems okay to stick with Vetsulin for now--at least it's the devil I am getting to know.

My vet had suggested feeding only before shots, but I didn't trust that for the reasons you mentioned. . . . I've been leaving food out for snacking as usual. She has always tended to grab a bite just before we settle in for bed, so maybe that habit will serve her in the night. I do suspect I changed her diet too quickly; lesson learned.

Thank you, too, for the testing advice. I teach and will soon have a couple of weeks off, so I'm hopeful of getting a handle on all of this while I have more time at home. This morning T's AMPS was 253 after no PM shot. I gave her just a half unit this morning and can at least get a +3 test, so we'll see how that goes. Fingers crossed.

All best to you!
Kerri

 

Welcome Kerri! Saw your post over in the Welcome Introduce yourself section and followed over here to make sure things were going ok for you and Tigger.

Baptism by fire for sure is not what any of us want to see, but you handled it well, have gotten some good suggestions from Linda (MrWorfMen's Mom) and have helped people here to help you better by adding that information in your signature. Well done!

Keep up the good work, and hope your Tigger girl feels better soon.

My own direct personal experience with a diabetic cat and switching him to a low carb food does suggest caution with the amount of insulin you are giving. My cat (different insulin than you are using) went from the 300+ BG range on a human meter down to normal in about 6 weeks. Took that long because Wink was a dry food addict and it took that amount of time to get him to realize that canned food was tasty.

Absolutely possible your cat could become diet controlled and not need insulin anymore. What we hope for most of all is that however you treat your cat, that Tigger feels better and acts more like themselves. No more lakes of pee in the litter box, normal pooping, interested in playing, purring, good appetite but not ravenous, normal weight, just acting all around like a normal cat.

ECID (every cat is different) and EOID (every owner is different) so you do the best you can with what you know and what you can learn here.

You journey with diabetes is a marathon not a sprint, and there are many people here with day to day experience with things you can try that might work for you and your cat. Deep breath, hold, release, deep breath, hold, release, deep breath, hold release. You can do this.

 

Just checking in on you and Tigger.

I see Tigger dropped to 82 early in the cycle yesterday and BG was up somewhat higher this AM. Not to worry. That is a normal phenomenon called bouncing. The drop of 171 points in 3 hours plus Tigger being used to being in higher BG range both contribute. When BG drops quickly or to levels kitty is has become unaccustomed to, their body defences go into action to bring BG back up to levels they perceive to be safer. Bounces can last up to 6 cycles so stay with the 0.5u dose and just wait Tigger out.

That 82 is getting a bit low on the AT2 (ideally you don't want kitty going much below 90) so monitor as best you can and if need be, you can also leave out slightly higher carb food for when you are not going to be around to monitor. Dose may need to be lowered even more if those low numbers keep appearing.

Are you using syringes and a vial or the Vetpen to administer the insulin? If you are using the Vetpen you can only adjust doses in 0.5u increments. With syringes that have half unit markings you can do dose adjustments of 0.25u so something to consider going forward.

 

Dear Deb and Linda,
Thank you both sooooooooo much.

Deb--your note popped up in my email just as I was heading into a long meeting at work today. I hated I couldn't respond right away, but I re-read it several times and took such comfort from your encouragement!

And Linda, thank you, thank you for checking out Tigger's chart for me. I don't feel we are in disaster mode so didn't want to be a pest, but I am so grateful for experienced eyes on my numbers. The 82 had me both relieved and nervous. . . . And SO grateful for your advice to switch to 1/2 unit. I read on here somewhere to pay more attention to low numbers than high, which definitely resonates against our hypo scares. All that made me think I should stick with the half-unit. But I am so grateful for the confirmation. My testing times today weren't ideal, but at least I could add a few more numbers and feel like nothing awful was happening while I was away from home.

Deb--yes, yes, yes to the normal-acting kitty. Tigger has been so much more herself the last couple of days, and her bathroom habits are so much improved. No more lakes of pee--hooray!

Linda--I do have syringes and a vial and had been wondering if .75 (or .25) might be right. But I'll hold off on changes until I see a few more numbers, yes?

Thank you both again for having Tigger on your radars. You are so kind to help.

 

Looks like Tigger might be clearing that bounce so be sure to get those night tests tonight and leave food out for Tigger to eat overnight. Right now I think the 0.5u is fine but as the food transition continues, the dose may need to be lowered to 0.25u.

 

Thank you so much, Linda! It's so hard for me to know what to make of the numbers, but your explanations make wonderful sense. Tigger does have food out--she has some out pretty much all the time. I would definitely love if she needs a lower dose soon.

 

All good here. Unfortunately I fell asleep on the couch and missed prime time for testing (a long strange week and my own body schedule is off!), but I woke up around 2AM (+7) and tested then. 212 and kitty acting fine. I'll do better with my testing tonight to try to catch that low point.

 

Kerri, You're doing great.

My internet connection can be quite unreliable (had to reboot my computer and internet connection twice this morning already - thanks Comcast!). Plus I have never personally used Vetsulin so I don't feel comfortable giving you help with dosing advice with that insulin because I'd want to more knowledgeable and be around to help if you had questions.

Encouragement is always something I can do though. Keep on with what you are doing and keep learning.

Is Tigger completely on low carb canned food now? or still transitioning?

Tigger feeling better, fewer 'lakes of pee' in the litter and being able to 'cat' again is a wonderful sign.

No worries on falling asleep. Remember, you need to take care of yourself first so you can then help your Tigger girl.

Cats nadir (get their lowest BG reading) at different times on different insulins and that can vary from day to day. For instance, my Wink was at his lowest around +3 or +4 (hours after the shot I mean) even though the 'normal' nadir point for the different Lantus insulin that he was on is around +6 . So, you kind of have to test around the window where most cats reach a low point to see where your cat goes low. It's one reason why we say "ECID" (every cat is different).

You are looking more for patterns in the numbers more than exactly the same every time, as there can be so much variability in the BG readings. It's one reason that color coded spreadsheet is a big help, it can help other people and you to see patterns.

Make sense?

 

Hi Deb (and Linda and anyone else who's reading!),
Yes!--to the color-coded sheet and to the idea of patterns. That makes so much sense--as does the breathe, hold, release mantra...I feel like I've been drinking from a firehose this week or so and have started reminding myself to breathe. And hold. And release. So powerful.

Tigger and I had a vet appt late this afternoon, and I was so happy to be able to show our vet our chart (instead of him getting one random reading from a very vet-stressy cat!) He seemed pleased, too.

I was so grateful for how supportive he was and for how carefully he considered Tigger's numbers.

While he had originally suggested 4 and then 3 units twice daily, he now thinks we should try one unit once daily. He is thinking Vetsulin might stick with Tigger longer than is typical (as Linda suggested a while back, I think).

I don't want to do anything fast, ever. So I'm thinking .25 tonight and .75 in the morning? And to keep testing. Happily, I'm home from work for a nice stretch now and can keep a close eye on my sweet girl.

Oh--Deb--you asked about where we are food-wise. We are close to all low-carb wet. Tigger had been eating both dry (usually something like Orijen) and wet (a random mix--as long as it was something fishy). She has always leaned toward dry but enjoys wet well enough. She also unfortunately was getting a LOT of junky treats (like Temptations, Friskies Party Mix, etc.). Why I would shell out $$$ for Orijen and also dole out handfuls of junky treats I can't explain--except that she sure loves those junky treats.

Anyway, as soon as we were diagnosed, I ditched the treats. It has been hard to get her to eat enough wet food, but I've been weaning her off her dry--in the last couple days I've just been leaving a tiny bit (maybe 2 TBSP) in her bowl. I ordered a bag of the Young Again Zero, which arrived yesterday. I see it has mixed reviews on this site, and I don't want her eating much of it. But she seems to like it fine, and I've subbed it in now for her old kibble--again just a very tiny bit in her bowl. Her grazing pattern tends to be nibble a few kibbles and then lap at the wet, so I'm hoping this keeps her appetite going without messing up her tummy. Fingers crossed. I know I am aiming for all wet--then maybe the Young Again can become "treats."

Gosh this note has gotten long, and thanks everyone for reading! And for all the support.

Kerri

 

Glad your vet was happy with the spreadsheet but it totally escapes me why he would suggest 1u once daily when Vetsulin usually only last 8 to 10 hours for most cats. Once a day dosing will not work and only serve to make regulating that much harder and make Tigger feel awful.

I'm also not sure why you reduced the dose to 0.25u tonight? Right now it looks like the dose may need to be increased to 0.75u to get the numbers down a bit more but consistent dosing day and night will work much better than different doses at least at this point in time when you are still regulating BG.

 

Hi Linda,
Thanks soooooo much for giving things another look!

About the .25, I was afraid to give any at all tonight b/c she was only at 211. . . . I thought she was supposed to be 230 (or 250) for any at all? But then vet was worried that morning numbers were going 300+, so I was afraid to give none at all tonight.

About the 1 unit. . . .He seemed to be especially pointing to 12/17/19 and wanting something more like that than what we've been having. He also noticed she was a little lower at +9 today than at +4. . . . But I have also been wondering if 1/2 isn't enough and maybe .75 AM & PM would work. (And also feeling like nothing may ever get sorted out until she settles back into consistent eating with her LC foods. Ugh.)

If you have a chance, could you help me know--even if some kitties tend to drop lower in the night than in the day, do we never give more in the morning and less at night?

I'm definitely not opposed to disregarding vet's advice.

Thanks!

 

Kerri, you are right that BG was not above 250 and I guess I missed that. Good catch/decision. Wasn't paying attention to how early you are in this dance and was thinking 200 as limit which is something you will work down to.

I agree the cycle on the 17th looks great but with the skipped shots the day before and low pre-shot at the end of cycle which wasn't shootable, it wasn't ideal. Looks good mid cycle but not at the back end. That's the problem with picking one day out of many and thinking that's the route to follow. It's the pattern overall that has to be considered rather than one day that might have been a very nice cycle. Focusing on only one cycle can be at best non productive and at worst dangerous. I've seen far too many cases of vets using one cycle of readings to make dose determinations and if readings happen to be high, they increase the dose too much.

Those higher BGs in the AM are common and probably a bit of bouncing from lower overnight numbers you just didn't necessarily catch with testing.

Vetsulin has 2 periods when BG drops occur. The first is usually between +3 and +6 post shot and the 2nd around +8/9 so that 2nd drop is what your vet observed today. Perfectly normal although the 2nd drop is often so subtle it isn't obvious.

Once you get your cat regulated and in good numbers, you might find a sliding scale or different AM/PM doses work well but until you hone in on a dose that gets numbers where you want them, giving different doses only confuses the picture.

 

Thank you, Linda, so much again! I was wondering if we needed to be looking more at those more recent numbers and less at those early ones. Shall I try .75 in the morning, would you think?

If you have a chance to answer that, I'll leave you alone for the night!

 

While I think dose may need to increase, right now I'd stick with 0.5u for a couple more cycles and make sure to get a test early in the night cycle like +2/3 to see what's happening then. The later tests are great but as per the cycle on the 17th, BG dropped early and nadir isn't always at the same time every day/night. I have a feeling we are missing some lower BGs in the night cycle and think it best to see if we can catch any to see how low they are before increasing the dose.

 

That sounds great. Thank you!

 

Hi Friends, [EDIT--I just realized I should probably have posted this in Main Health. Please disregard below; I'll move to Main Health now. Thanks!]

I'm hopeful for another round of advice (and not sure whether I should have started a new thread). My spreadsheet is up-to-date but a little wonky, sometimes with multiple readings in the PS boxes as I waited to see if BG was rising. I tried to keep everything clear by adding +13, +14 tags there.

My update--
I stuck with my 1/2 unit dosing for several cycles, as Mr.WorfMen's Mom advised. Starting on 12/23 I bumped up to .75 unit in AM. I kept the PM dose at .5 (and was away from home on nights of 12/23 and 12/24 so unfortunately couldn't test in the night). For both those nights I DID come home to test, feed, shoot).

Yesterday was the third AM dose of .75, and I was home a lot for testing day and night. As you can see, Tigger stayed in the blue (unless I missed a green somewhere along the way) for 24 hours straight. Now, at 25 hours since her last shot, she is back up to 209. I am assuming she should get another dose but I don't trust myself. Should I try another .75?

EDIT--I held off on doing anything. . . . After another 2 1/2 hours, she was 197.

Thanks, all!
Kerri